Date Presented 04/05/19
A lower-extremity strengthening exercise (LESE) program addressing high-intensity interval training was designed to improve the lower limb function of people with chronic psychiatric disorders. This clinical control trial showed that the 16-week LESE program significantly increased clients' lower limb muscle strength and endurance. OTs working with the client population should include lower-extremity exercises as a preparatory task for supporting occupation-based activities.
Primary Author and Speaker: Wan-Chi Hsu
Additional Authors and Speakers: Eric Hwang
Contributing Authors: Pei-Yun Wang, Shang-Liang Wu, Hui-Ling Lee
PURPOSE: This study examines the efficacy of a lower extremity strengthening exercise (LESE) program implemented by occupational therapists (OTs) for inpatients with chronic psychiatric disorders (CPD) in a psychiatric center of Taiwan.
RATIONALE: Individuals with CPD are found to be more sedentary and less physically active than their counterparts. Accordingly, studies also indicate a high prevalence of poor lower limb function among this client population. Intervention for these clients should include exercises that enhance lower extremity function because of its significance to mobility and daily activities.
DESIGN: This was a non-randomized control trial in which participants were assigned purposefully into one of the 3 groups through matching their gender, age, diagnosis, time since onset, and body mass index (BMI): (1) LESE 3 times a week (E3), (2) LESE once a week (E1) and (3) control group with routine activities (C). The 16-week-long LESE program emphasized high intensity interval training (HIIT) with the repetition of movements such as squat, jump, standing leg lift, run etc. Each LESE session lasted 30 minutes including the first and last 5 minutes of the warm-up and cool-down sessions, respectively.
PARTICIPANTS: The study recruited 150 inpatients aged 18 to 65 with CPD who were deemed appropriate for the study by the medical team and who did not sustain other medical diagnoses or medication side effects that would significantly affect physical function.
DATA COLLECTION: Independent variable was LESE with 3 levels (groups): E3, E1 and C. Dependent variables were: (1) lower limb skeletal muscle mass (LLSMM) measured by InBody 230, a body-composition analyzer, (2) lower limb skeletal muscle strength (LLSMS) measured by the 30-sec Sit to Stand Test, (3) lower limb skeletal muscle endurance (LLSME) measured by the 60-sec Sit to Stand Test, and (4) lower limb skeletal muscle power (LLSMP) measured by the Standing Long-Jump Test. All dependent variables were tested 3 times: pre-intervention, post-1 (at 8th week) and post-2 (at 16th week). Control variables included BMI, gender, age, diagnosis, onset age and time since onset.
ANALYSIS: Chi-square test and ANOVA were used to preselect significant control variables. The generalized estimating equation (GEE) was then used to compare group differences across time with the control variables offset.
RESULTS: Among the 150 participants, 97 completed the study. Compared to C group, E3 group showed significantly higher increase in LLSMS and LLSME between pre and post-2 tests (p=0.05 and 0.03). However, the differences between C group and E1 group were not significant. In the 30-sec and 60-sec Sit to Stand Tests, E3 group increased the total number of stands by 3.6 and 6.9, respectively. No significant group differences were found in LLSMM and LLSMP across time.
CONCLUSION: The lower extremity strengthening exercise emphasizing high intensity interval training (HIIT) 3 times a week and 30 minutes per session can improve lower limb skeletal muscle strength and endurance for clients with chronic psychiatric disorders. Strategies to enhance the clients' sustained motivation throughout the exercise program are also needed. Future studies should be geared to the type of exercise that will significantly improve lower limb skeletal muscle mass and power for the client population.
IMPACT STATEMENT: Lower limb muscle function serves as a foundation for mobility and occupational performance. As stated in the Occupational Therapy Practice Framework: Domain and Process (3rd ed.), OTs working with clients with chronic psychiatric disorders should include lower extremity strengthening exercises as a preparatory task for supporting the clients' occupation-based activities.
References
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